晚期肺癌一线免疫联合治疗症状随访依从性的影响因素分析  

Influencing Factors of Symptom Follow-up Adherence in Advanced Lung Cancer Patients Receiving First-Line Immune Checkpoint Inhibitor Combination Therapy

作　　者：胡瀚 贾蓉 王晓珊[3] 郑于珠[4] 王柯 杨帆 熊竹娟[5] 王绎 谢华[2] 魏星 石丘玲 戴维[6] 周进 Hu Han;Jia Rong;Wang Xiaoshan;Zheng Yuzhu;Wang Ke;Yang Fan;Xiong Zhujuan;Wang Yi;Xie Hua;Wei Xing;Shi Qiuling;Dai Wei;Zhou Jin(School of Clinical Medicine,Southwest Medical University,Luzhou 646000,Sichuan,China;Department of Medical Oncology Sichuan Clinical Research Center for Cancer,Sichuan Cancer Hospital&Institute,Sichuan Cancer Center,University of Electronic Science and Technology of China,Chengdu 610041,Sichuan,China;Department of Medical Oncology,SichuanAcademy of Medical Sciences&Sichuan Provincial People's Hospital,Chengdu 610000,Sichuan,China;Department of Medical Oncology,the Third People's Hospital of Chengdu,Chengdu 610000,Sichuan,China;Department of Nutritional Medicine Sichuan Clinical Research Center for Cancer,Sichuan Cancer Hospital&Institute,Sichuan Cancer Center,University of Electronic Science and Technology of China,Chengdu 610041,Sichuan,China;Department of Thoracic Surgery Sichuan Clinical Research Center for Cancer,Sichuan Cancer Hospital&Institute,Sichuan Cancer Center,University of Electronic Science and Technology of China,Chengdu 610041,Sichuan,China;School of Public Health,Chongqing Medical University,Chongqing 400016,China)

机构地区：[1]西南医科大学临床医学院,四川泸州646000 [2]四川省肿瘤医院·研究所,四川省肿瘤临床医学研究中心,四川省癌症防治中心,电子科技大学附属肿瘤医院,肿瘤内科,成都610041 [3]四川省医学科学院·四川省人民医院肿瘤科,成都610000 [4]成都市第三人民医院肿瘤科,四川成都610000 [5]四川省肿瘤医院·研究所,四川省肿瘤临床医学研究中心,四川省癌症防治中心,电子科技大学附属肿瘤医院临床营养科,成都610041 [6]四川省肿瘤医院·研究所,四川省肿瘤临床医学研究中心,四川省癌症防治中心,电子科技大学附属肿瘤医院胸外科,成都610041 [7]重庆医科大学公共卫生学院,重庆400016

出　　处：《肿瘤预防与治疗》2025年第1期18-26,共9页Journal of Cancer Control And Treatment

基　　金：广东省临床试验协会/中国胸部肿瘤研究协作组和广东省肺癌转化医学重点实验室开放课题(编号:YC20210105);2022CSCO重点项目(编号:Y-2021AST/zd-0119)。

摘　　要：目的:探索在患者报告结局背景下,接受一线免疫联合治疗的晚期肺癌患者症状随访依从性的影响因素。方法:分析来源于2022年6月至2023年7月多中心前瞻性队列研究中168例晚期肺癌患者的相关资料。根据每周平均随访时长将患者分为随访依从性好(≤24小时)和随访依从性差(>24小时),采用多元Logistic回归分析患者随访依从性的影响因素。结果:168例晚期肺癌患者中,113例随访依从性好,55例随访依从性差,中位每周随访时长为14小时。单因素分析结果显示,居住地、文化程度、就业状况、美国东部肿瘤协作组行为状态(Eastern Cooperative Oncology Group performance status, ECOG-PS)评分、营养风险筛查2002(Nutritional Risk Screening 2002,NRS-2002)评分、肿瘤病理类型、患者最佳疗效与患者随访依从性显著相关(均P<0.05)。多因素分析结果显示,就业状况、肿瘤病理类型、ECOG-PS及NRS-2002评分是患者随访依从性的独立影响因素(均P<0.05)。结论:全职或兼职就业、小细胞癌、ECOG-PS评分≥2和NRS-2002评分≥3的患者随访依从性差,报告数据质量存在欠佳可能,此类人群应加强宣教,并重点关注随访的及时性和可靠性。Objective:To investigate the influencing factors of symptom follow-up adherence in patients with advanced lung cancer receiving first-line immune checkpoint inhibitor combination therapy based on patient-reported outcomes.Methods:The data of 168 advanced lung cancer patients from multicenter prospective cohort studies between June 2022 and July 2023 were analyzed.The patients were classified into two categories:good adherence(≤24 hours)and poor adherence(>24 hours),according to the average follow-up length in each week.Multivariate logistic regression was used to analyze factors associated with follow-up adherence.Results:A total of 168 patients were enrolled in this study.Among them,113 were in a good adherence level,55 were in a poor adherence level,with median weekly follow-up length of 14 hours.Univariate analysis results indicated that place of residence,education,employment,Eastern Cooperative Oncology Group performance status(ECOG-PS)score,Nutritional Risk Screening 2002(NRS-2002)score,pathological type and best overall response were significantly correlated to follow-up adherence(all P<0.05).Multivariate analysis results further suggested that employment,pathological type,ECOG-PS score and NRS-2002 score were independent influence factors for follow-up adherence(all P<0.05).Conclusion:The follow-up compliance of patients with full-or part-time employment,small cell carcinoma,ECOG-PS score≥2 and NRS-2002 score≥3 is poor,and the quality of patient-reported data may be suboptimal.Therefore,the priority should be given to patients with the above characteristics,especially in the timeliness and reliability of follow-up.

关 键 词：肺肿瘤 免疫检查点抑制剂 随访依从性 影响因素 患者报告结局 

分 类 号：R734.2[医药卫生—肿瘤] R730.51[医药卫生—临床医学]